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Yr3 Surgery: Orthopaedics > Shoulder 3 > Flashcards

Shoulder 3 Flashcards

1
Q

Remind yourself of the anatomy of the clavicle

A
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2
Q

What age groups are clavicular fractures common in?

HINT: bimodal

A
  • Adolescents & young adults
  • 60yrs (onset of osteoporosis)
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3
Q

What classification system is used to classify clavicular fractures?

A

Allman classification

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4
Q

Describe the Allman Classification

A

Type 1

  • # middle third
  • 75% (as middle third is weakest)
  • Generally stable
  • But significant deformity present

Type 2

  • # lateral third
  • 20%
  • When displaced, they are unstable

Type 3

  • # medial third
  • 5%
  • Associated multi-system polytrauma
  • May be associated with neurovascular compromise, pneumothorax or haemothorax
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5
Q

Describe how the medial and lateral segment of clavicle will displace in a #clavicle

A
  • Medial: elevate due to SCM
  • Lateral: depressed due to weight of arm > strength/support from trapezius
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6
Q

Describe some common mechanisms of injury for #clavicle

A
  • Direct trauma
  • Indirect trauma e.g. fall onto shoulder
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7
Q

State symptoms of a #clavicle

A
  • Pain
    • Sudden onset
    • Localised
    • Severe
    • Worsened by active movement of arm
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8
Q

What might you find on examination of someone with #clavicle

A
  • Tenderness over clavicular region
  • Deformity (medial elevation, lateral depression)
  • Open injuries
  • Threatend skin (tented, tethered, white & non-blanching skin. May convert to open injury)
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9
Q

What must you assess for if someone presents with #clavicle?

A

Neurovascular compromise

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10
Q

What investigations would you do if you suspect #clavicle?

A
  • X-ray of clavicle (AP and modified axial)
  • ?CT: might be needed to asses medial clavicle injuires as these can be hard to assess on x-rays
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11
Q

Discuss the management of #clavicle

A

Most managed conservatively even if there is significant deformity.

  • Sling (to support elbow& improve deformity. Kept on until regain pain-free movement)
  • Encourage early movement of shoulder

Surgery is required for open fractures. Surgery for other #clavicle is controversial. ORIF required if fracture failed to unite.

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12
Q

State some potential complications of #clavicle

A
  • Non-union
  • Neuorovascular injury
  • Puncture injury to lung resulting in pneumothorax or haemothorax
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13
Q

What is the healing tiem for clavicular fractures?

A

4-6 weeks

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14
Q

Remind yourself of the anatomy of the humerus

A
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15
Q

Who are humeral shaft fractures common in?

HINT: bimodal

A
  • Younger pts (high energy trauma)
  • Older pts (low impact, osteopenia/osteoporosis)
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16
Q

State some risk factors for humeral shaft fractures

A
  • Age
  • Osteoporosis
  • Previous fractures
17
Q

State typical mechanism of injury in humeral shaft fracture

A
  • Fall on outstretched limb
  • Fall laterally onto adducted limb
18
Q

What are symptoms of humeral shaft fracture?

A
  • Pain
  • Deformity
  • If radial nerve involved:
    • Reduced sensation dorsum 1st webspace
    • Weakend wrist extension
19
Q

What might you find on clinical examination of a pt with humeral shaft fracture?

A
  • Deformity
  • Weakness wrist extension
  • Reduced sensation over dorsal 1st webspace
  • Open wounds
20
Q

What must you assess when examing a pt with #humeral shaft?

A

Neurovascular status

21
Q

Where do majority of humeral shaft fractures occur?

A

Medial third

22
Q

What nerve is at risk in #humeral shaft and why?

A

Radial nerve as it passes through radial groove then runs along lateral edge of humeral shaft

23
Q

The radial nerve is most likely to be damaged in what type of humeral shaft fracture?

A
  • Holstein-Lewis fracture
  • Fracture to distal 1/3 of radius
  • Results in entrapment of radial nerve

*Requires surgical management

24
Q

What investigations are required for humeral shaft fractures?

A

X-ray: AP & lateral

25
Q

Discuss the management of humeral shaft fractures

A

Mainstay of management= realignment of limb.

Conservative

  • Humeral brace (used in most fractures of diaphysis)
  • High elbow case (if very distal fracture of humerus)
  • Regular follow up & repeated x-rays

Surgical

  • Surgical fixation only needed in minority. Open reduction & internal fixation
26
Q

How long does it typically take for the full union a humeral shaft fracture?

A

8-12 weeks

27
Q

State some potential complications of humeral shaft fractures

A
  • Non-union & mal-union (rare)
  • Varus angulation (rarely causes functional limitation as shoulder can compensate)
  • Radial nerve injury (90% improve in 3/12 without intervention)
28
Q

Where is the most common site for a shoulder fracture?

A

Proximal humerus

29
Q

Who do shoulder fractures commonly occur in?

A

Most commonly occur in elderly pts with osteoporosis who have fallen on outstretched hand

30
Q

State some risk factors for a shoulder fracture

A

Risk factors are the risk factors for osteoporosis:

  • Female
  • Age
  • Early menopause
  • Prolonged steroid use
  • Recurrent falls
  • Frailty
31
Q

State the symptoms of a shoulder fracture

A
  • Pain aroudn upper arm & shoulder
  • Restricted movement
  • Inability to abduct arm
32
Q

What might you find on clinical examination of someone with a shoulder fracture?

A
  • Swelling
  • Bruising
  • Restricted movement
  • Damage to axillary nerve:
    • Loss of sensation in regimental badge area
    • Loss of power of deltoid muscle
33
Q

What should you always assess in a supsected shoulder fracture?

A

Neurovascular status

34
Q

What investigations would you do in a suspected shoulder fracture?

A
  • X-rays (AP, lateral scapular, axillary)

Others you may do:

  • Trauma: urgent bloods- coagulation screen, group & save
  • Pathological cause suspected e.g. cancer- serum calcium, myeloma screen
35
Q

What classification system can be used to classify proximal humeral fractures?

*Don’t worry about details of it, just know neer classificaiton used to classify

A

Neer Classification: classifies fractures based on relationship between 4 main segments of proximal humerus. Classified as displaced if >1cm between segments or at least 45 degrees angulation. Classifies into minimal displacemtn or two to four part injuries.

  • Greater tuberosity
  • Lesser tuberosity
  • Articular segment (anatomical neck)
  • Humeral shaft (surgical neck)
36
Q

Discuss the management of proximal humeral fractures

A

Majority managed conservatively:

  • Immobilisation initially followed by early mobilisation at 2-4 weeks
  • Polysling
  • Physiotherapy

Srugery indicated if fracture is open, displaced or neurovascular compromise. Surgery may include ORIF, intermedullary nailing, hemiarthroplasty, reverse shoulder atrhoplasty.

37
Q

State some potential complications of a proximal humerus fracture

A
  • Reduced range of omotion
  • Avascular necrosis of humeral head
38
Q

Scapular fractures are very rare; true or false?

A
  • True
  • Scapula protected by surrounding muscles
  • Associated almost exclusively with high impact trauma
  • Majority treated non-operatively
  • Good results & no functional deficits in most cases

Yr3 Surgery: Orthopaedics (14 decks)

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